eMedicine Specialties > Ophthalmology > Extraocular Muscles

Abducens Nerve Palsy: Treatment & Medication

Author: Michael P Ehrenhaus, MD, Director, Department of Cornea, External Disease & Refractive Surgery, Assistant Professor, Department of Ophthalmology, State University of New York Downstate Medical Center
Coauthor(s): Mohammedyusuf E Hajee, MD, Clinical Instructor, Staff Physician, Department of Ophthalmology, Director, Blood Flow Laboratory, State University of New York-Downstate Medical Center; Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Contributor Information and Disclosures

Updated: May 21, 2009

Treatment

Medical Care

Truly isolated cases often are benign. They can be followed with a serial examination, at least every 6 weeks, over a 6-month period to note decreasing symptoms (diplopia) and resolution of the paretic lateral rectus (increasing motility).11,3

Children with sixth nerve palsy who are in the amblyopic age group can be treated with an alternating patching to decrease their chances of developing any amblyopia in the paretic eye. Additionally, prescribing the full amount of hyperopic correction helps to decrease the esodeviation by relaxing the child's accommodative effort.

Adult patients and those children beyond the amblyopic age can be patched or have their lenses "fogged" with clear tape or nail polish to reduce their diplopia. Fresnel prisms also can be prescribed as an alternative.

Older patients in whom giant cell arteritis is a consideration should start the standard treatment with prednisone or intravenous methylprednisolone as soon as possible.

Surgical Care

If after 6 months of follow-up care the remaining deviation is still unacceptable and is too large to be corrected with prisms, surgical corrective options should be discussed with the patient. The procedure that is chosen depends on the remaining function of the lateral rectus and the experience of the surgeon.

If some residual function exists in the lateral rectus, a graded recession/resection is the procedure of choice.

When little or no residual function is present, a transposition procedure, such as the Hummelsheim or the Jensen, can be used, along with, in appropriate patients, weakening the antagonist ipsilateral medial rectus.

Consultations

With persistent defect, a neurology consult may be needed.

Activity

Patients who occlude an eye to alleviate diplopia should be warned that the resulting effects on depth perception may interfere with their ability to drive or perform certain occupations safely.

More on Abducens Nerve Palsy

Overview: Abducens Nerve Palsy
Differential Diagnoses & Workup: Abducens Nerve Palsy
Treatment & Medication: Abducens Nerve Palsy
Follow-up: Abducens Nerve Palsy
References
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References

  1. Evans NM. Ophthalmology. 2nd ed. Oxford University Press Inc; 1995.

  2. Kline LB, Bajandas FJ. Neuro-ophthalmology Review Manual. 3rd ed. University of Alabama, Birmingham; 1988.

  3. Yanoff M, Duker JS. Ophthalmology. Mosby International Ltd; 1999.

  4. Ayberk G, Ozveren MF, Yildirim T, et al. Review of a series with abducens nerve palsy. Turk Neurosurg. Oct 2008;18(4):366-73. [Medline].

  5. Denis D, Dauletbekov D, Girard N. Duane retraction syndrome: Type II with severe abducens nerve hypoplasia on magnetic resonance imaging. J AAPOS. Feb 2008;12(1):91-3. [Medline].

  6. Calisaneller T, Ozdemir O, Altinors N. Posttraumatic acute bilateral abducens nerve palsy in a child. Childs Nerv Syst. Jul 2006;22(7):726-8. [Medline].

  7. Dwarakanath S, Gopal S, Venkataramana NK. Post-traumatic bilateral abducens nerve palsy. Neurol India. Jun 2006;54(2):221-2. [Medline].

  8. Kurbanyan K, Lessell S. Intracranial hypotension and abducens palsy following upper spinal manipulation. Br J Ophthalmol. Jan 2008;92(1):153-5. [Medline].

  9. Hanu-Cernat LM, Hall T. Late onset of abducens palsy after Le Fort I maxillary osteotomy. Br J Oral Maxillofac Surg. Dec 16 2008;[Medline].

  10. Anwar S, Nalla S, Fernando DJ. Abducens nerve palsy as a complication of lumbar puncture. Eur J Intern Med. Dec 2008;19(8):636-7. [Medline].

  11. Rhee DJ, Pyfer MF. The Wills Eye Manual: Office and Emergency Room diagnosis and treatment of eye disease. Lippincott Williams & Wilkins; 1999.

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Further Reading

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Keywords

abducens nerve palsy, sixth nerve palsy, VI nerve palsy, 6th nerve palsy, cranial nerve VI palsy

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Contributor Information and Disclosures

Author

Michael P Ehrenhaus, MD, Director, Department of Cornea, External Disease & Refractive Surgery, Assistant Professor, Department of Ophthalmology, State University of New York Downstate Medical Center
Michael P Ehrenhaus, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Contact Lens Association of Ophthalmologists
Disclosure: Nothing to disclose.

Coauthor(s)

Mohammedyusuf E Hajee, MD, Clinical Instructor, Staff Physician, Department of Ophthalmology, Director, Blood Flow Laboratory, State University of New York-Downstate Medical Center
Mohammedyusuf E Hajee, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, and National Medical Association
Disclosure: Nothing to disclose.

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Andrew W Lawton, MD, Medical Director of Neuro-Ophthalmology Service, Section of Ophthalmology, Baptist Eye Center, Baptist Health Medical Center
Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Brian R Younge, MD, Professor of Ophthalmology, Mayo Clinic School of Medicine
Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

James P Gills, MD, Founder, St Luke's Cataract and Laser Institute; Professor, Department of Ophthalmology, University of South Florida College of Medicine
James P Gills, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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